1. Answer: B

Rationale: Using Nagele’s Rule, by using the date of the first day of her last menstrual period, add 7 days, then subtract 3 months, and add 1 year. In the case of the given patient, the first day of her LMP was August 20, 2018, we add 7 days which is August 27, 2018. Subtract 3 months, giving us May 27, 2018 then add one year, thus her estimated date of confinement is May 27, 2019.

2. Answer: D

Rationale: 16 weeks of gestation is part of the second trimester. During the second trimester, a pregnant patient may experience physical changes such as Braxton Hicks contraction, skin changes, nasal problems, dental issues, leg cramps and vaginal discharge. Other symptoms mentioned above are experienced during the first trimester.

3. Answer: A

Rationale: A monthly breast self-examination has been proven to be the most effective way for early detection of breast cancer. About 95% of lumps are being detected by women themselves. Up to 15% of the lumps are only detected through check-up with a physician every 3 years. Mammogram are less effective in younger patients, but they are more effective for women older than 40 years old.  Ultrasound is useful only when trying to distinguish if the cysts from solid masses and their location.

4. Answer: C

Rationale: Immediate intervention to reduce swelling and bleeding is to rest, ice, compression and elevation (RICE). This also applies to a patient with hemophilia.

5. Answer: C

Rationale: A patient with IDA must choose a restful activity which could keep them from being bored. Reading a book is the most appropriate activity for patients with anemia. Choice A, B and D requires a lot of energy from a patient with anemia and may increase the oxygen demand.

6. Answer: B

Rationale: Failure to pass meconium within the first 24 hours after birth may indicate Hirschsprung disease. Hirschsprung diseases is a congenital defect resulting in a mechanical obstruction due to inadequate motility in a segment in the intestine. Failure to pass out meconium is not associated with Celiac disease, abdominal wall defect and intussusception.

7. Answer: A

Rationale: After T and A (tonsillectomy and adenoidectomy), liquids and soft foods are best tolerated by the patient because the throat is still sore. Hard and scratchy foods are to be avoided until the throat is fully healed.

8. Answer: C

Rationale: A child with rheumatic fever has usually very tender joint pains that even the weight of the bed linens could cause pain. By using bed cradles, the weight of bed linens are alleviated on the painful joints. Joints need to be maintained in a good alignment and not on an extended position, in order to stay functional. Using rolled pillows to support the alignment of the patient does not usually relieve pain. Tractions are usually used to relieve muscle spasms which are not associated with rheumatic fever.

9. Answer: D

Rationale: A post-operative child with cleft palate should be placed on their abdomen in order to facilitate drainage. Placing a child in a supine position may induce aspiration. Placing a child on a high chair does not facilitate drainage as well as placing a child on his side or supine position.

10. Answer: B

Rationale: A patient with acetaminophen toxicity should present right upper quadrant pain because of hepatic damage from glutathione combining with the metabolite of acetaminophen being broken down.

11. Answer: A

Rationale: A low sodium diet is helpful in order to reduce the frequency and severity of disease episodes.

12. Answer: D

Rationale: The burn victim should not be in a place where he is able to acquire an infection easily such as someone with a possibility of having a flu with unspecified temperature, a patient with enterococcal infection and a patient with measles. Sickle disease is not an infectious disease.

13. Answer: B

Rationale: A patient with pulmonary embolism usually present with tachypnea, tachycardia, dyspnea and chest pain. A patient with COPD patient may also present with shortness of breath but should have a history of smoking and may produce wheezes under auscultation. An asthmatic patient may also present with shortness of breath and dyspnea, but shall also present wheezes upon auscultation. A bronchitis patient may also present with shortness of breath accompanied by productive cough and fatigue.

14. Answer: D

Rationale: The nurse’s role as a client advocate is to promote the client’s rights and to be able to make the proper decision and choices.

15. Answer: B

Rationale: As a nurse, you should assess the patient’s ability to acquire food and you also should be able to assess why the client isn’t eating properly.

16. Answer: A

Rationale: Short term memory loss is frequent among elderly, therefore written lists and the use of calendars is helpful in assisting the patient to remember and recalls information about their medication. Talking to a family member does not involve the patient and choice C and D is not helpful, as the patient may still forget the instructions.

17. Answer: D

Rationale: Subjective data is the information that the patient feels and can describe in his own words. Objective data is the information that the nurse can observe and measure.

18. Answer: C

Rationale: Cyanosis is the result of a decrease in the level of oxygen in the blood.

19. Answer: B

Rationale: Vomiting may cause loss of acidic fluids which results in alkalosis. The cause is metabolic and not respiratory in origin.

20. Answer: B

Rationale: Medications given via intravenous route should begin working within 1 to 5 minutes.

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